College health is a desired outcome created by a constellation of services, programs and policies directed at advancing the health and wellbeing of individuals enrolled in an institution of higher education, while also addressing and improving both population health and community health. Many colleges and universities worldwide apply both health promotion and health care as processes to achieve key performance indicators in college health. The variety of healthcare services provided by any one institution range from first aid stations employing a single nurse to large, accredited, multi-specialty ambulatory healthcare clinics with hundreds of employees. These services, programs and policies require a multidisciplinary team, the healthcare services alone include physicians, physician assistants, administrators, nurses, nurse practitioners, mental health professionals, health educators, athletic trainers, dietitians and nutritionists, and pharmacists. Some of the healthcare services extend to include massage therapists and other holistic health care professionals. While currently changing, the vast majority of college health services are set up as cost centers or service units rather than as parts of academic departments or health care delivery enterprises.
Ever increasing levels of college health often requires comprehensive environmental management, the coordination of resources, and institutional accountability for addressing the negative health impacts from alcohol use disorder and other substance abuse, mental illnesses such as depression and general anxiety disorders, sexual assault and discrimination among others. The creation of innovative strategies to address the behavioral determinants of health among post-secondary students continues to pose challenges for institutions worldwide.
Common health concerns of college and university students
Distress
A common college health key performance indicator relates to levels and the management of stress. Distress is the a negative result from the body's adaptation to change. A post-secondary education contains both distress and eustress. Many institutions of higher education have a reputation for being high-stress environments. Throughout college or university, students often experience increased academic-related expectations, as well as a heightened level of overall responsibility that can adversely affects a student's wellbeing.
Likewise, students in post-secondary are often expected to balance social, financial, personal and professional responsibilities, while maintaining a strong academic performance. As a result, students in post-secondary often experience an increase in their overall stress level, compounded by a decreased perception of their own quality of life. With stress being a common aspect of students' academic experiences, the correlation between stress and compromised quality of life has become an area of increasing concern in post-secondary. In recent studies, stress has been shown to contribute to the formation of maladaptive coping strategies in post-secondary students, which can subsequently increase one's risk for developing adverse health complications throughout college or university, including depression. Additionally, factors such as physical and mental exhaustion, along with decreased sleep performance as a result of stress at university or college can be a major detriment to a student's perceived life satisfaction.
Academic Post-secondary students experience stress from a variety of sources in their daily life, including academics. In a 2017 American College Health Association report, 47.5% of post-secondary students claimed that they considered their academic stress to be 'traumatic or very difficult to handle.' Disturbed sleep patterns, social problems, and homesickness are all major factors that can increase a student's perceived level of stress, including academic stress.
Academic competition is another major source of stress in post-secondary students' lives. High levels of colleague competitiveness has been reported to have a positive correlation with depression and anxiety in post-secondary students. Furthermore, while competition in academic environments can often be a perceived as a strong motivator to students, overall evidence suggests that it can also contribute to unhealthy levels of stress in an individual.
Learning how to develop effective strategies to manage personal stress in an academic setting can therefore help protect one against the risk of developing health complications in post-secondary. Yoga, breathing-techniques, and mindfulness interventions are all practices that have been proven to reduce stress among college students. Specifically, cortisol in students who engage in cognitive- and behavioral-based techniques has been proven to decrease post-intervention. Furthermore, studies suggest exercise and physical activity may have a protective effect against stress in post-secondary students.
Social pressures, bullying, and hazing Bullying and harassment are documented contributors to psychological distress in higher education. Research indicates that college environments may produce forms of intimidation ranging from interpersonal peer conflict to workplace harassment among graduate students and academic researchers, which may negatively affect mental health and academic functioning.Keashly, L. (2021). "Workplace bullying, mobbing and harassment in academia". British Journal of Guidance & Counselling. 49(4), 525–539.
In addition to these forms of bullying, social pressures surrounding fraternities and sororities have become a significant concern on many U.S. campuses. Greek-life organizations may foster environments where conforming to group norms, experiencing social exclusion, or participating in risky initiation practices can create substantial emotional strain. Hazing, defined as any activity expected of someone seeking to join a group that humiliates, degrades, abuses, or endangers regardless of willingness, has been linked to serious physical and psychological harm.Allan, E. J., & Madden, M. (2008). Hazing in View: College Students at Risk. University of Maine.
Multiple high-profile hazing incidents have resulted in hospitalization, severe trauma, or death. Research indicates that forced alcohol consumption, physical coercion, sleep deprivation, and psychological manipulation can lead to long-term mental health consequences, including post-traumatic stress symptoms, heightened anxiety, and impaired academic performance.Campo, S., Poulos, G., & Sipple, J. (2005). "Prevalence and profiling: Hazing among college students and points of intervention". American Journal of Health Behavior. 29(2), 137–149. Studies also suggest that campus climates dominated by Greek-life social norms produce secondary stress for non-affiliated students, especially when high-risk behaviors influence broader campus culture.Hoover, N. C., & Pollard, N. (2000). Initiation Rites and Athletics. Alfred University.
Personal Intra-personal distresses, including perceived concerns relating to body-image and self-esteem, are common in adolescence. Furthermore, unhealthy body-image has been associated with a number of negative health complications, notably depression and disordered eating behaviors. Post-secondary institutions have therefore become widely recognized as ideal grounds for implementing evidence-based health interventions that provide students the opportunity to manage and improve their overall self-image.
Financial stress is also a major burden on students' health and wellbeing, as the academic term employs the expenditure of one's financial resources "without guarantees of a satisfactory return." In a 2019 report by The College Board on "Trends in College Pricing," the average tuition for full-time students attending a four-year-long post-secondary institution in the 2019–2020 academic year was about $12,700. With the costs of post-secondary education growing significantly over the last decade, many students are choosing to take out student loans to support their education. As a significant source of stress, student debt and financial instability have been linked to poorer general health outcomes and higher rates of depressive symptoms in young adults. Personal debt has also been associated with increased drug and alcohol use.
Adverse effects on health The mental health of students can sometimes decline when attending college. Therefore, this increased stress has highlighted the need for mental health and counseling services available to students on campus. According to the American Psychological Association (APA), there was a 30% rise in students seeking psychological healthcare services on American campuses between the 2009–2010 and 2014–2015 academic year, with 61% of these students seeking counselling for anxiety, 49% seeking counselling for depression, 45% seeking counselling for stress, and 28% seeking counselling for concerns regarding academic performance.
Mental illness Late adolescence and early adulthood is a window of onset for many psycho-social-behavioral illnesses. Therefore, mental health disorders are often first diagnosed in college students. In a survey of 14,000 college students from 8 different countries, researchers found that approximately 35% of students had an undiagnosed mental health illness. An estimated 75% of all lifetime mental disorders are developed by the age of 24. Common mental health problems among college students include anxiety disorders, depression, ADHD, sleep disorders, and suicide.
Depression Major depressive disorder affects more than 16.1 million Americans over the age of 18 in a given year. Mental health issues can hinder student success in college. However, oftentimes college students experiencing depression have not been diagnosed. Demographically, upperclassmen, college students, and those living off campus are considered more likely to be depressed. Common concerns that lead to depression among college students include pressure to perform well academically, worries about success, and thoughts about post-graduation plans. The American College Health Association has been established for students with depression to provide resources, programs, and guidelines and promote mental health services.
Anxiety disorders College students can experience significant stress and anxiety from having to balance a multitude of responsibilities such as managing rigorous coursework, participating in extracurricular activities, maintaining relationships, working, and managing finances. Anxiety or excessive worry can cause significant impairment in general functioning. Symptoms of general anxiety disorder include restlessness, difficulty concentrating, irritability, fatigue and sleep disturbances. In a 2018 survey, the American College Health Association reported that 63.4% of college students experienced overwhelming anxiety and 22.1% were diagnosed or professionally treated within the last 12 months. Students may also experience social anxiety disorder which is characterized by significant anxiety or fear of judgment or embarrassment in social situations such as meeting or conversing with new people, public speaking, and attending parties or social gatherings. As with depression, students with social anxiety disorder are more likely to have lower attendance and participation rates. Students that have experienced significant traumatic events such as sexual assault may develop post-traumatic stress disorder. In 2015, Association of American Universities conducted a survey on sexual assault misconduct in colleges. 11.7% of students reported to have experienced nonconsensual penetration or sexual touch by physical force or incapacitation while in college. Students with untreated anxiety disorders are at greater risk for drug and alcohol abuse.
Sleep disorders